Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain.
CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
Alzheimers Res Ther. 2017 Sep 12;9(1):71. doi: 10.1186/s13195-017-0297-z.
Due to the progressive aging of the population, Alzheimer's disease (AD) is becoming a healthcare burden of epidemic proportions for which there is currently no cure. Disappointing results from clinical trials performed in mild-moderate AD dementia combined with clear epidemiological evidence on AD risk factors are contributing to the development of primary prevention initiatives. In addition, the characterization of the long asymptomatic stage of AD is allowing the development of intervention studies and secondary prevention programmes on asymptomatic at-risk individuals, before substantial irreversible neuronal dysfunction and loss have occurred, an approach that emerges as highly relevant.In this manuscript, we review current strategies for AD prevention, from primary prevention strategies based on identifying risk factors and risk reduction, to secondary prevention initiatives based on the early detection of the pathophysiological hallmarks and intervention at the preclinical stage of the disease. Firstly, we summarize the evidence on several AD risk factors, which are the rationale for the establishment of primary prevention programmes as well as revising current primary prevention strategies. Secondly, we review the development of public-private partnerships for disease prevention that aim to characterize the AD continuum as well as serving as platforms for secondary prevention trials. Finally, we summarize currently ongoing clinical trials recruiting participants with preclinical AD or a higher risk for the onset of AD-related cognitive impairment.The growing body of research on the risk factors for AD and its preclinical stage is favouring the development of AD prevention programmes that, by delaying the onset of Alzheimer's dementia for only a few years, would have a huge impact on public health.
由于人口的老龄化进程，阿尔茨海默病（AD）正在成为一种具有流行规模的医疗保健负担，而目前尚无治愈方法。轻度至中度 AD 痴呆症的临床试验结果令人失望，加上 AD 风险因素的明确流行病学证据，都促成了初级预防措施的发展。此外，AD 无症状阶段的特征描述使得可以对无症状高危个体进行干预研究和二级预防计划，而在发生大量不可逆转的神经元功能障碍和丧失之前，这种方法变得非常重要。在本文中，我们回顾了 AD 预防的当前策略，从基于识别风险因素和降低风险的初级预防策略，到基于病理生理学特征的早期检测和疾病临床前阶段干预的二级预防计划。首先，我们总结了几个 AD 风险因素的证据，这些证据是建立初级预防计划以及修订当前初级预防策略的基础。其次，我们回顾了公私合作伙伴关系在疾病预防方面的发展，这些合作旨在描述 AD 连续体，并作为二级预防试验的平台。最后，我们总结了目前正在招募具有临床前 AD 或更高 AD 相关认知障碍发病风险的参与者的临床试验。AD 风险因素及其临床前阶段的研究不断增加，有利于 AD 预防计划的发展，这些计划通过仅将阿尔茨海默病痴呆的发病时间推迟几年，将对公共卫生产生巨大影响。
